Epidemiology

‘I Want the Best People Entering the Field to Want to Be Here’

After her first few weeks on the job, new Epidemiology chair Maria Glymour discusses her expansive vision for the department.

The transition from spring to summer is always a blur, but forgive Maria Glymour if that blur has been especially pronounced this season.

She officially started June 1 as the new chair of the Department of Epidemiology, but has spent much of the past few hectic weeks coordinating a cross-country move, settling into multiple rounds of meetings with new SPH colleagues, and actively representing the School at the Society for Epidemiologic Research (SER) conference.  

Boston has held a special appeal for Glymour; she received her masters and doctorate from the Harvard School of Public Health, and was an assistant professor there for several years. For the past 10 years, Glymour was a professor at the University of California San Francisco (UCSF), where her research centered around several intersecting themes.

Dementia risk and age-related cognitive decline have been central pillars of her work, along with examining related outcomes such as stroke and Alzheimer’s. She also studies the effect of social inequalities on health throughout the life course, including how social policies can influence people’s risk for less-healthy aging.

The third major theme, which Glymour says is driven by the other two, is her enduring interest in statistical methods. She says research on dementia and social inequalities are brimming with methodological problems, but those problems are key to doing work on social inequalities and critical to making that research translational. If researchers hope their work does more than just describe inequalities by moving towards influencing policies that end inequalities, Glymour says there is great importance in recognizing when to say, “Well actually, this isn’t just associated, it’s causal.”

What drew you to this course of study?

I really love public health. There are probably 17 topics in public health that I could have focused on and been just delighted. I grew up in a pretty rural place in Oklahoma and there were a lot of public health issues in Oklahoma. As you can imagine, there are a lot of challenges related to poverty and related to the history of the state. So there were lots of public health issues that were very compelling to me.

I also grew up around a lot of fabulous old people, so I was very interested in the things that make a difference for old people. After college, I actually started working in a nursing home, a memory-care facility, and that was pretty amazing for me. The people were incredible and it was such a juxtaposition of the loss related to memory impairment and of the continuing and compelling humanity of people, even in the context of that disease. It is a very devastating disease, but there’s still people you come to care about very much and want to make sure that their lives are as rich as you can make them.

That was a really galvanizing experience for me. It was very compelling and the people I worked with were very compelling. The pay was terrible, the ways that staff were treated was terrible, but the work was amazing and it made me interested in dementia-related conditions and what that means for people.

How can the early stages of education play a fairly important role in cognitive health much later in life?

One of the pleasures of this career stage is seeing how your half-baked idea from your dissertation has been done much, much better by others. In my dissertation, I was particularly interested in whether education was protective against dementia. The problem with that is that cognitive test scores at every age—even in childhood—predict dementia later in life.

What we did to get around that was say, ‘Look, there are all these policies that places have that influence how much school people get.’ In fact, in the United States, we went from being a country where most people did not attend high school to being a country where most people completed high school in a pretty good period of time. We could show that, in fact those legal changes at the state level predicted cognitive outcomes and dementia risk decades later.

We showed this in the United States, and then it’s been replicated in many countries. As places change policies, one of the things that has been interesting in more recent years is an extension to think more carefully about racially stratified experiences. One very early work suggested, especially in southern states, that compulsory schooling laws were not enforced for Black children.

Pre-Brown v. Board of Education, states engaged in racial segregation that would set different term lengths for Black children compared to white children. For example, you could see states that would only require 110 days in the school year for segregated schools for Black children, whereas the standard school year as we currently know it is 180 days. These school length policies were set at the state level and now that’s predicting differences in outcomes when they are older adults.

Based on your research, have you identified any other policies that are worth examining for those longer-term effects?

I am excited about the next generation of emerging scholars who are applying more intersectional approaches. One of my postdoctoral researchers, Dr. Marilyn Thomas, is studying how experiences at Historically Black Colleges and Universities (HBCUs) might be protective and beneficial for Black students. They are studying the ways that Black people brought into White spaces are encountering interpersonal discrimination and that is important to further understanding inequities in outcomes.

Other really wonderful work on dementia led by post-docs includes evaluating how community disinvestment is shaping dementia inequities [Dr. Kendra Sims], the impact of the COVID pandemic on people living with cognitive impairment or dementia [Ruijia Chen], the influence of delays in diagnosis on outcomes [Min Hee Kim], and the effects of emerging medications on outcomes [Sarah Ackley]. This is really the tip of the iceberg as there’s a whole cohort of early career scientists fielding rigorous and novel studies on prevention of dementia and the drivers of inequalities in dementia.

You mentioned that there are several interdisciplinary projects that you’re excited to be involved with that are using new data sources. What are some of those new sources that are giving you so much optimism as you join Boston University?

There have been changes in what is possible with data infrastructure, data resources, and computational resources. Epidemiology has to take advantage of that—health research in general has to take advantage of that. I’m very interested in building capacity across a wide array of applied topics. BU is a great place in terms of data infrastructure and the commitment to using innovative computational tools to make progress.

One example of the work that SPH is doing that I’m excited about is on Climate and Health, as it is one of the biggest health threats we’re facing. This an area where data infrastructure matters a lot to be able to ask questions and get rigorous answers. BU also has a very strong foundation in hiring folks and supporting those who are doing that work.

More broadly, I think there’s been an underuse, historically, of certain methods for causal inference, and part of the reason we’ve underused them is that we haven’t had the data infrastructure. These two things kind of fit together. I come from a strong commitment to causal inference approaches because I think that that’s how you solve health equity issues. If you want to move beyond describing health equity or health injustices and saying, ‘This is what we do to reduce those injustices and reduce those inequalities,’ those are causal questions. It’s incumbent on us to bring the best methods to bear to address those questions. We’ve been using a particular set of causal inference tools, but I think there is a broader set of causal inference tools that can deliver rigorous policy-relevant evidence that I would love to pursue. Broadly, those are within the context of quasi-experimental or natural experiments, or pragmatic trials or light touch trials, or encouragement designs. I’d love to foster some of the research taking advantage of those approaches.

What’s your ideal vision of what the EPI department will look like in five years?

I want the best people entering the field to want to be here, to know that this is the place to learn the skills that they need to do their science. And no matter the science that they care about or feel passionately about, I want them to believe that this is the place that will support them in doing that work. When they’re accepted to BU or recruited here for a faculty, staff, or career development role, they should know that it is because we think their work is super-important and we believe they can excel here. And I hope they believe this is the place where they can get the skills and resources to do the work they care the most about.

It’s really hard to do good science. I want to make sure that we have an educational program that supports people at every phase. I’d love to see our alumni taking leadership roles in epidemiology and health research all across the country and internationally. That’s part of our role in public health, to train broadly, giving people the core skills and frameworks to do fantastic work wherever they are. I am excited about hiring faculty and I am very excited about our educational vision. It’s been a treat to talk to people and say, ‘Send me your best folks. We’re hiring.’

We are also hoping to think about how we’re funding students. One of the challenges in funding students in public health—and this is not just BU, this is everywhere in EPI—is tying student funding to faculty research. One idea we’re discussing as faculty is how to get structured training grants and support for career development awards for students to help them work with earlier career faculty, and to help them pursue distinct research agendas separate from their work as research assistants.

I think there’s often a sense that education is about the classwork, but that is obviously not only what is happening at a university. The classes are one part of it, but so much of what happens are the talks and spending time with your mentor, spending time with your peers problem solving and debating. I had a great conversation with Megan Healey and Ann Aschengrau about how we evaluate the educational programs. Our students are smart, highly energetic, devoted people, and our job is to give them guidance and help them get where they’re going.

What do you believe will be the biggest challenge when you step through the doors?

Like at any school of public health, there’s a lot of stress. There’s a lot of pressure to get grants and get papers finished. But at the end of the day, we’re here in a school of public health and we need each other. We need to collaborate. People can’t learn if they don’t admit what they don’t know. You need to make a space where people feel, ‘We are in this together. We’re learning stuff together. We’re figuring it out.’ And there’s a sense of camaraderie and connectedness about tackling the problems that we all care about.

It is a moment of real challenge for all of us in public health, and I am excited to be at BUSPH. I want to be able to create a space for all of us to come together and be intentional about the community we want to build, together.